Systematic Review on Hydroxyapatite and Chitosan Combination-coated Titanium Implants on Osseointegration.

Duraisamy, Revathi; Ganapathy, Dhanraj; Shanmugam, Rajeshkumar; Thangavelu, Lakshmi

Aim: To systematically examine existing scientific literature to assess the effectiveness of hydroxyapatite (HA) and chitosan (CS) combination coatings on titanium (Ti) implants. Background: Osseointegration is the key to success of dental implants. Ti alloy is widely used for its biocompatibility, ductility, and strength. HA and CS-coated Ti implants showed improved osseointegration. HA and CS have their own merits and demerits. The high elastic moduli of Ti alloys used in dental implants induce bone resorption, causing alveolar bone remodeling due to insufficient stress stimulation on bone tissue, leading to implant failure. Also, Ti alloys are highly susceptible to bacterial growth due to their reduced osteoconductive and osteoinductive property. To combat the abovementioned disadvantages, various surface modifications, biofunctionalization, and texture fabrication in combination with antibacterial nanoparticles have been performed on Ti alloys. Materials and methods: The search strategy was carried out in PubMed, Cochrane Library, Scopus, Web of Science, and Google Scholar with no language and date of publication restriction to identify experiments that compared the osseointegration of HA-coated and CS-coated Ti dental implants. All in vitro and in vivo studies comparing the same were included. RoBDEMAT and SYRCLE's risk assessment tools were used to evaluate the risk of bias (RoB) for in vitro and in vivo studies. Review results: A total of 73 articles were obtained. On removing the duplicates and screening for title and abstract, three full-text articles were then assessed for eligibility criteria. Two were excluded for not satisfying the inclusion criteria. One article which remained also does not adhere to strict eligibility criteria. However, it compared the HA/CS complex-coated Ti dental implants with different porosities. RoB was found to be moderate for the in vitro and in vivo experiments of the included article. In vitro and in vivo assessments that compared the effect of HA/CS complex-coated porous Ti dental implants showed improved osseointegration than nonporous, noncoated solid Ti dental implants. Conclusion: Enhanced osseointegration was observed in the HA and CS complex-coated porous Ti dental implants, potentially improving implant success in compromised bone. Further extensive human trials are necessary to fully validate these findings across diverse clinical scenarios. Clinical significance: Excellent osseointegration of HA and CS complex-coated porous Ti dental implants can facilitate successful implant placement and improved performance in compromised and porous bone.

World Journal of Dentistry, 2024, Vol 15, Issue 1, p79

0976-6006

Academic Journal

10.5005/jp-journals-10015-2358